Healthcare Provider Details

I. General information

NPI: 1871657007
Provider Name (Legal Business Name): SHERIDAN M BILEN DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N SCOTT ST SUITE A
NAPOLEON OH
43545
US

IV. Provider business mailing address

1411 N SCOTT ST SUITE A
NAPOLEON OH
43545
US

V. Phone/Fax

Practice location:
  • Phone: 419-592-1781
  • Fax: 419-592-0000
Mailing address:
  • Phone: 419-592-1781
  • Fax: 419-592-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20405
License Number StateOH

VIII. Authorized Official

Name: MR. SHERIDAN M BILEN
Title or Position: OWNER
Credential: DDS
Phone: 419-592-1781